|Year : 2020 | Volume
| Issue : 3 | Page : 197-199
Sarcoidosis of eyelid
Rwituja Thomas, Parvathi Hari, Roshmi Gupta
Department of Orbit, Oculoplasty and Ocular Oncology, Narayana Nethralaya, Bengaluru, Karnataka, India
|Date of Submission||12-May-2020|
|Date of Acceptance||20-Jul-2020|
|Date of Web Publication||14-Sep-2020|
Dr. Rwituja Thomas
Oculoplasty and Oncology Services, Narayana Nethralaya, 121/C, Chord Road, Rajajinagar, Bengaluru - 560 010, Karnataka
Source of Support: None, Conflict of Interest: None
A 53-year-old woman presented with plaque-like lesions on the upper and lower lids of both eyes including the tear trough. To confirm the diagnosis, incisional biopsy of one of the lesions was done. Histopathology confirmed the diagnosis to be sarcoidosis, with typical noncaseating granulomatous changes. Systemic evaluation revealed hilar lymphadenopathy. She was treated with oral steroids, and the lesion had completely resolved by 3 months. Sarcoidosis of the eyelids is a rare condition and may present as the first manifestation. An early biopsy can help confirm diagnosis and avoid systemic morbidity.
Keywords: Eyelid plaque, eyelid sarcoidosis, sarcoidosis
|How to cite this article:|
Thomas R, Hari P, Gupta R. Sarcoidosis of eyelid. TNOA J Ophthalmic Sci Res 2020;58:197-9
| Introduction|| |
Sarcoidosis is a granulomatous infiltrative multisystem disease with dermatologic as well as ophthalmic manifestations. It usually occurs in the third to fourth decades and is more common among women.
Pulmonary involvement is the most common manifestation. Ocular involvement occurs in 25%–60% of patients with systemic sarcoidosis., It can involve any ocular structure, but anterior uveitis and dacryoadenitis are the most common manifestations reported. Eyelid manifestations of sarcoidosis are rare, and very few reports are available in literature.
| Case Report|| |
A 53-year-old woman presented with swelling on the upper and lower lids of both eyes for 1 week. The patient did not have any systemic complaints. On examination, she had a raised plaque-like well-demarcated lesion on the lower and upper lids of both eyes measuring about 10 mm × 5 mm size [Figure 1]. The locations of the lesions were typical of xanthelasma. The skin over the lesion was hyperpigmented. The lesion was firm in consistency and nontender. On palpation, the lesions appeared to be subcutaneous in location but free from deeper tissues. Ocular examination was unremarkable.
Biopsy obtained from the lesion showed noncaseating granulomatous reaction with epithelioid cells and Langhans-type giant cells, which was suggestive of sarcoidosis [Figure 2]a. Ziehl–Neelsen staining was negative [Figure 2]b. On further evaluation, computed tomography scan showed hilar lymphadenopathy [Figure 3]. Serum angiotensin-converting enzyme (ACE) level was 43 units/l. Mantoux test was negative. She was started on oral prednisolone1 mg/kg, tapered over 12 weeks, and reviewed regularly. The eyelid lesions had completely resolved at the end of 4 months [Figure 4].
|Figure 2: (a) Histopathology: Photomicrograph showing noncaseating granulomas with epithelioid cells and Langhans giant cells and lymphocyte infiltrates. (b) Histopathology: Ziehl–Neelsen staining showing no acid-fast bacilli|
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| Discussion|| |
The most common orbital manifestation of sarcoidosis is involvement of the lacrimal gland. Eyelid involvement is a rare manifestation of sarcoidosis. Earlier reports suggest an incidence of about 12%. The common sarcoidosis lesions in the eyelid skin include millet-seed nodules, plaque, nodules, or ulcerated appearance. A rare presentation was described in 1990 with nodules of both lids near the medial canthi. The patient also had multiple such lesions on the arm and face. Biopsy of the eyelid lesion confirmed the diagnosis. A 34-year-old female presenting with flesh-colored papular lesions near the medial canthal area in both eyes has also been reported.
Recurrent painless swelling of eyelids and the periorbital region is the other common presentation., A 70-year-old female with a similar presentation on evaluation had hilar lymphadenopathy and an old tubercular scar in the chest X-ray. Tubercular skin test and immunoglobulin assay were negative for tuberculosis; serum ACE and erythrocyte sedimentation rate were elevated. Excision biopsy of the lesion confirmed the diagnosis. The patient was treated with oral steroids, and the lesions had resolved completely in 12 weeks.
A lateral canthal nontender erythematous mass in a patient with raised ACE and hilar lymphadenopathy and nonspecific scarring of the lungs was reported. Despite treatment with intralesional steroids, excision biopsy done 9 months later was consistent with sarcoidosis-like features.
In the present case, the patient was systemically asymptomatic with no past history of sarcoidosis. She presented with swelling on both eyes, located subcutaneously. These lesions were located in the area where typically a xanthelasma is seen. A biopsy was considered as the lesions did not conform to any characteristic appearance, with firm consistency and hyperpigmentation of the overlying skin.
Management strategies for eyelid sarcoidosis include intralesional steroid, surgical debulking of large lesions, and medical therapy with oral steroids and immunosuppressants. The lesions respond well to oral steroids generally, as seen in the present case where complete resolution of the lesion was seen over a period of 4 months.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]